The Centers for Medicare and Medicaid Services (CMS) are required to cover medical services deemed reasonable and necessary for its beneficiaries.1 While most services are covered without controversy, a small fraction receive additional scrutiny, formalized in national coverage decisions that dictate the terms of coverage for services considered to be particularly important. Some novel treatments require enrollment in a research study intended to generate evidence specific to patients receiving Medicare benefits, a process known as coverage with evidence development (CED).2 However, recent decision making by CMS calls into question the application of the CED pathway for patients with pacemakers or implantable cardioverter-defibrillators (ICDs) who require magnetic resonance imaging (MRI). We argue that current CMS policy for patients with capped or epicardial leads needlessly restricts access to potentially life-changing treatment, while also limiting investigators’ ability to gather further evidence for clinical care and Medicare coverage.